| Doctor Name: | MR. JIMMY LOUIS PHILLIPS |
| NPI Number: | 1003811555 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.P.C. |
| License Number: | 180000228 |
| Business Practice Address: | 3915 N Sheridan Rd Unit R Peoria, IL - 616147135 |
| Business Phone Number: | 3096819432 |
| Business Fax Number: | 3096819164 |
| Mailing Address: | 3915 N Sheridan Rd Unit R, PEORIA |
| State: | IL |
| Postal Code: | 616147135 |
| Phone Number: | 3096819432 |
| Fax Number: | 3096819164 |
| NPI Enumeration Date: | 06/20/2005 |
| NPI Last Update Date: | 06/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180000228 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |